The NRA has blocked gun violence research for 20 years. Let's end its stranglehold on science.

Photo montage shows some of the victims of Sunday's mass shooting in Orlando. How many deaths could have been averted with a better understanding of causes and remedies of gun violence? (AP)

The Orlando massacre reminds us that there's an enormous amount we don't know about gun violence — what causes it, what its consequences are for surviving families, how to stop it. You can blame our ignorance on the National Rifle Assn. – and on the federal officials the NRA has intimidated away from this crucial field of public health for 20 years.

It's widely supposed that Congress enacted a "ban" on federal funding for gun violence research in 1996. That isn't quite true, says Mark Rosenberg, a gun violence expert who was head of the federal Centers for Disease Control and Prevention's National Center for Injury Prevention and Control at the time. But the truth is even more demoralizing.

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If research on cancer were stopped for a single day, there would be a huge protest. But this research has been stopped for 20 years.

Mark Rosenberg, former head of CDC injury prevention program

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Infuriated by CDC-funded research suggesting that having firearms in the home sharply increased the risks of homicide, the NRA goaded Congress in 1996 into stripping the injury center's funding for gun violence research – $2.6 million. Congress then passed a measure drafted by then-Rep. Jay Dickey (R-Ark.) forbidding the CDC to spend funds "to advocate or promote gun control." (The NRA initially hoped to eradicate the injury center entirely.)

The Dickey Amendment didn't technically ban any federally funded gun violence research. The real blow was delivered by a succession of pusillanimous CDC directors, who decided that the safest course bureaucratically was simply to zero out the whole field.

Remarkably, that approach has continued to the present day: After the Newtown massacre of schoolchildren in 2012, President Obama issued an executive order instructing the CDC to "conduct or sponsor research into the causes of gun violence and the ways to prevent it." But the agency has refused unless it receives a specific appropriation to cover the research. Congress played its obligatory role in acting as the NRA's cat's-paw by repeatedly rejecting bills to provide $10 million for the work.

"Removing the money from the budget and enacting the Dickey Amendment were the first and second shots across the bow by the NRA," Rosenberg said. "The third shot is the idea that if you do this research, you'll be hassled" by the NRA. "The result is that the CDC basically does nothing in gun violence research. If research on cancer were stopped for a single day, there would be a huge protest. But this research has been stopped for 20 years."

The consequence is that we're flying blind on gun violence. Rosenberg and other experts list four topics on which research is crucial. First is the scale of the problem — how many people are shot, is the number rising or falling, who gets shot, under what circumstances, and with what weapons? Second, what are the causes? "What leads people to shoot other people or kill themselves?" Rosenberg asked. (Two-thirds of gun deaths are suicides, he said.)

Third is learning what works to prevent gun violence, and fourth is figuring out how to translate these findings into policy. Legislators across the country have enacted laws allowing open-carry of firearms on the street or in public places, or authorizing teachers to carry arms in the classroom or on campus, "with no idea whether that would result in more people being killed or more lives being saved," Rosenberg said.

We found that keeping a gun in the home was strongly ... associated with an increased risk of homicide ... by a family member or intimate acquaintance.

Kellermann, et. al., New Engeland Journal of Medicine, 1993

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More research would solve some of the intriguing riddles in the field. "Over the last 15 years or so," said Garen J. Wintemute, head of the Violence Prevention Research Program at UC Davis, "the rate of fatal firearms violence — homicide and suicide — hasn't changed much. But the rate of fatal gun violence in California has fallen by about 20% Figuring out what California policies or conditions have contributed to this divergence would be invaluable for federal and state lawmakers contemplating new legislation."

Research funding almost invariably flows to urgent issues, as it did with motor vehicle deaths. "We as a country have a tradition that when a crisis strikes, we mobilize," said Wintemute, who lost about $1.5 million in federal research funding after the Dickey Amendment. "With firearms, we've consciously and deliberately choked off" the response.

The research that spurred the NRA's 1996 campaign underscores what the organization thought was at stake. Conducted by a team headed by Arthur L. Kellermann, then at the University of Tennessee, the study investigated the consequence of firearms in the home. Drawing from statistics in the Memphis, Seattle and Cleveland metropolitan areas, Kellermann found that "keeping a gun in the home was strongly and independently associated with an increased risk of homicide … by a family member or intimate acquaintance." Even after controlling for such factors as illicit drug use, criminal records or a history of domestic violence, the risk was found to be almost three times higher than in homes without firearms.

This was a blow to the NRA because "it saw that would not help them sell more guns," Rosenberg observed. Kellermann's paper, which was published in the New England Journal of Medicine in 1993, noted that "protection from crime" was the most commonly cited rationale for having guns in the home. Forced entry by an intruder accounted for a tiny subgroup of real cases, though it loomed large in the fears of homeowners. "A gun kept in the home is far more likely to be involved in the death of a member of the household than it is to be used to kill in self-defense," Kellermann wrote. "In the light of … our present findings, people should be strongly discouraged from keeping guns in their homes."

The NRA attacked the Kellermann study for its methodology and findings, but the impact on research funding was far more effective and long-lived. A generation of researchers was discouraged from entering a field in which grants were hard to come by and the political push-back intense.

In recent years, a few glimmers of light have appeared, Wintemute said: "Though Congress hasn't seen fit to study the problem, California is on the verge of stepping up." A bill in the state Senate would establish a gun violence research program at the University of California at an estimated cost of $1 million-$2-million a year. On Tuesday, meanwhile, the American Medical Assn. at its annual meeting passed a resolution urging Congress to overturn what it described as a prohibition on gun violence research. "An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement and society at large may be able to prevent injury, death and other harms to society resulting from firearms," AMA President Steven Stack said after the vote.

Whether this will be enough to turn the research ship around will be unclear as long as the NRA holds its death grip on congressional action. "Right now we're suffering something that's worse than terrorism," Rosenberg said. "It's fatalism."

The toll of gun violence may mark an end to that era. "How many people are dead whose deaths might have been prevented," Wintemute said, "if we had been able to find answers to the problem."